Osteoporosis: Should I Have a Dual-Energy X-Ray Absorptiometry (DXA) Test

Guides through decision to have a dual-energy X-ray absorptiometry (DXA) test for osteoporosis. Explains DXA test. Includes risk factors for osteoporosis you can and cannot change. Covers benefits and risks. Includes an interactive tool to help you decide.

Osteoporosis: Should I Have a Dual-Energy X-Ray Absorptiometry (DXA) Test?

You may want to have a say in this decision, or you may simply want to follow your doctor's recommendation. Either way, this information will help you understand what your choices are so that you can talk to your doctor about them.

Your options

Have the DXA test to find out whether you need treatment for
osteoporosis.

Don't have the test.

Key points to remember

It's important to know if you are at risk for
osteoporosis. The DXA test measures bone thickness to
find out if you have osteoporosis or if you are at risk for a broken bone
(fracture).

The
United States Preventive Services Task Force
(USPSTF) recommends that women age 65 or older have routine tests to measure their bone
thickness. If you are at increased risk for fractures caused by osteoporosis, routine
screening should start sooner.1

Experts suggest that older men talk to their doctors about osteoporosis and have a bone density test if they are at risk.2

You
probably don't need this test if:

You are at low risk for osteoporosis and
are younger than 65.

You have osteoporosis but are not willing to make lifestyle changes or take medicines to treat
it.

The test may be a good choice for you if you
are at risk for osteoporosis and are willing to make
lifestyle changes and take medicines to treat it.

Osteoporosis is a disease
that affects your bones. It means that your bones are thin and brittle, with
lots of holes inside them like a sponge. This makes them easy to break.
Osteoporosis can lead to broken bones (fractures) in the hip, spine, wrist, and
other parts of your body. These fractures can be disabling and may make it hard
for you to live on your own.

The
United States Preventive Services Task Force
(USPSTF) recommends that women age 65 or older have routine tests to measure their bone
thickness. If you are at increased risk for fractures caused by osteoporosis, routine
screening should start sooner.1 USPSTF recommends that you and your doctor check your fracture risk using a tool such as FRAX to help decide whether you should be screened for osteoporosis. Talk to your doctor about your risk factors and when to start bone density screening.

The FRAX tool was developed by the World Health Organization to help predict your risk of having a fracture related to osteoporosis in the next 10 years. You can use this tool. Go to the website at www.sheffield.ac.uk/FRAX, and click on Calculation Tool. If you have had a bone density test on your hip, you can type in your score. If you have not had that test, you can leave the score blank.

Here are some other things to think about:

You may also want to have this test if you have
a low-trauma fracture. Low trauma means that you broke a bone doing something
that would not normally cause a broken bone, such as a simple fall.

Experts suggest that older men talk to their doctors about osteoporosis and have a bone density test if they are at risk.2

Your doctor may want you to have a follow-up bone density test after you have been on treatment. If this is suggested for you, it is done no more than every 2 years.
Getting follow-up tests doesn't make your treatment work better.

If you are younger than 65 and don't have any risk factors for osteoporosis, this test won't be very useful. You
may want to have the test when you reach age 65. But in the meantime, if you
are worried about getting osteoporosis, talk with your doctor about lifestyle
changes you can make to keep your bones strong.

If you
are at risk for osteoporosis and have a healthy
lifestyle but are not willing to take medicines for treatment, the test may not
be helpful. The results of the test would not change what you are already doing
to keep your bones strong.

Personal stories about deciding whether to have a bone density test

These stories are based on information gathered from health professionals and consumers. They may be helpful as you make important health decisions.

I am
uncertain about taking medicines for osteoporosis. I have a few risk factors
for osteoporosis, but not many. I think that knowing my bone density would give
me at least one objective piece of information I can use to make the medicine
decision. It would also give me a baseline, so if I'm tested again in the future I can tell if my bone density has changed.

Janet, age
65

I have a number of risk factors for
osteoporosis, and I have watched my mother's struggle with spinal fractures
over the past few years. In her day, they didn't know as much about using
hormones after menopause to prevent "brittle bones." I already take calcium and
vitamin D and have already decided that I will take osteoporosis medicine, so
my doctor and I agree that for now there is no real reason for me to have a
bone density test.

Annamaria, age 51

I slipped on the ice last week and broke
my wrist. It didn't seem like a very serious fall, and the doctor said that
because of my age, she wondered if perhaps I might have osteoporosis. I had
decided not to take hormones when I went through menopause, and I probably
haven't been getting quite as much calcium as I should. I am going to have the
bone density test and see if maybe I have osteoporosis. I hear there are some
medicines that can help treat it. And either way, I will definitely start
taking my calcium supplements.

Elsie, age 71

I was
surprised to find that I don't have any risk factors for osteoporosis other
than getting older. And I've always enjoyed drinking milk, so I don't have a
problem getting enough calcium. I exercise, and I don't smoke or drink. Really,
I think my bones are healthy! I'm not taking hormones after menopause, and I
feel like I am at such low risk of getting osteoporosis that the bone density
test isn't something I need at this point. I'm going to talk it over with my
doctor.

Sharon, age
55

What matters most to you?

Your personal feelings are just as important as the medical facts. Think about what matters most to you in this decision, and show how you feel about the following statements.

Reasons to have a DXA test

Reasons not to have a DXA test

I think I'm at risk for osteoporosis, and I want to know for sure.

I don't think I'm at risk for osteoporosis.

More important

Equally important

More important

I'm willing to make lifestyle changes and take medicines if I am at risk.

I'm not willing to make any changes or take medicines.

More important

Equally important

More important

The cost of the test doesn't bother me.

I'm worried about the cost of the test.

More important

Equally important

More important

My other important reasons:

My other important reasons:

More important

Equally important

More important

Where are you leaning now?

Now that you've thought about the facts and your feelings, you may have a general idea of where you stand on this decision. Show which way you are leaning right now.

Having the test

NOT having the test

Leaning toward

Undecided

Leaning toward

What else do you need to make your decision?

Check the facts

1.

Is getting the bone density test a good choice for everyone?

YesSorry, that's not right. You probably don't need this test if you are at low risk for osteoporosis and are younger than 65.

NoYou're right. You probably don't need this test if you are at low risk for osteoporosis and are younger than 65.

I'm not sureIt may help to go back and read "Get the Facts." You probably don't need this test if you are at low risk for osteoporosis and are younger than 65.

2.

Is it important to know your risk for osteoporosis?

YesYou're right. It is important to know your risk for osteoporosis. But you can find out without getting a bone density test.

NoSorry, that's not right. It's important to know your risk for osteoporosis. But you can find out without getting a bone density test.

I'm not sureIt may help to go back and read "Get the Facts." It's important to know your risk for osteoporosis. But you can find out without getting a bone density test.

Qaseem A, et al. (2008). Screening for osteoporosis in men: A clinical practice guideline from the American College of Physicians. Annals of Internal Medicine, 148(9): 680–684. Also available online: http://www.acponline.org/clinical_information/guidelines/guidelines.

You may want to have a say in this decision, or you may simply want to follow your doctor's recommendation. Either way, this information will help you understand what your choices are so that you can talk to your doctor about them.

Osteoporosis: Should I Have a Dual-Energy X-Ray Absorptiometry (DXA) Test?

Here's a record of your answers. You can use it to talk with your doctor or loved ones about your decision.

Get the facts

Compare your options

What matters most to you?

Where are you leaning now?

What else do you need to make your decision?

1. Get the Facts

Your options

Have the DXA test to find out whether you need treatment for
osteoporosis.

Don't have the test.

Key points to remember

It's important to know if you are at risk for
osteoporosis. The DXA test measures bone thickness to
find out if you have osteoporosis or if you are at risk for a broken bone
(fracture).

The
United States Preventive Services Task Force
(USPSTF) recommends that women age 65 or older have routine tests to measure their bone
thickness. If you are at increased risk for fractures caused by osteoporosis, routine
screening should start sooner.1

Experts suggest that older men talk to their doctors about osteoporosis and have a bone density test if they are at risk.2

You
probably don't need this test if:

You are at low risk for osteoporosis and
are younger than 65.

You have osteoporosis but are not willing to make lifestyle changes or take medicines to treat
it.

The test may be a good choice for you if you
are at risk for osteoporosis and are willing to make
lifestyle changes and take medicines to treat it.

FAQs

What is osteoporosis?

Osteoporosis is a disease
that affects your bones . It means that your bones are thin and brittle, with
lots of holes inside them like a sponge. This makes them easy to break.
Osteoporosis can lead to broken bones (fractures) in the hip, spine, wrist, and
other parts of your body. These fractures can be disabling and may make it hard
for you to live on your own.

What is the DXA test?

The
DXA is an X-ray test that measures bone thickness. It
is used to see if your bones are getting thin and brittle, which means they
could break more easily.

The results of the test may show that
you need treatment for osteoporosis.

What can increase your risk for osteoporosis?

A
risk factor is anything that can increase your risk of getting a disease. Some
risk factors you can change so that you reduce your risk. Others you can't
change.

Risk factors you can't change
include:

Your age. Your risk for osteoporosis goes up
as you get older.

Being a woman who has gone through
menopause. After menopause, your body makes less
estrogen. Estrogen protects the body from bone loss.

Your family
history. Osteoporosis tends to run in families.

Having a slender
body frame.

Your race. People of European and Asian background are
most likely to get osteoporosis.

Your health. You may be at
higher risk if you have a medical problem such as
hyperthyroidism that makes it hard for your body to
absorb enough
calcium.

Having surgery to remove your
ovaries before menopause.

Risk factors you can change
include:

Smoking.

Not getting enough
weight-bearing exercise, such as running, walking, or lifting
weights.

Drinking large amounts of alcohol.

Not getting enough calcium and
vitamin D.

Using
steroid medicines for 6 months or longer. But you may
not be able to stop taking these, depending on why you are taking them.

Who should get a bone density test?

The
United States Preventive Services Task Force
(USPSTF) recommends that women age 65 or older have routine tests to measure their bone
thickness. If you are at increased risk for fractures caused by osteoporosis, routine
screening should start sooner.1 USPSTF recommends that you and your doctor check your fracture risk using a tool such as FRAX to help decide whether you should be screened for osteoporosis. Talk to your doctor about your risk factors and when to start bone density screening.

The FRAX tool was developed by the World Health Organization to help predict your risk of having a fracture related to osteoporosis in the next 10 years. You can use this tool. Go to the website at www.sheffield.ac.uk/FRAX, and click on Calculation Tool. If you have had a bone density test on your hip, you can type in your score. If you have not had that test, you can leave the score blank.

Here are some other things to think about:

You may also want to have this test if you have
a low-trauma fracture. Low trauma means that you broke a bone doing something
that would not normally cause a broken bone, such as a simple fall.

Experts suggest that older men talk to their doctors about osteoporosis and have a bone density test if they are at risk.2

Your doctor may want you to have a follow-up bone density test after you have been on treatment. If this is suggested for you, it is done no more than every 2 years.
Getting follow-up tests doesn't make your treatment work better.

What can you expect if you get a bone density test?

If you have risk factors for osteoporosis and choose to get the test, the
results can help you make decisions about treatment. Treatment can help
strengthen bones and prevent fractures.

What can you expect if you do NOT get a bone density test?

If you are younger than 65 and don't have any risk factors for osteoporosis, this test won't be very useful. You
may want to have the test when you reach age 65. But in the meantime, if you
are worried about getting osteoporosis, talk with your doctor about lifestyle
changes you can make to keep your bones strong.

If you
are at risk for osteoporosis and have a healthy
lifestyle but are not willing to take medicines for treatment, the test may not
be helpful. The results of the test would not change what you are already doing
to keep your bones strong.

Why might your doctor recommend a DXA test?

Your
doctor may advise you to get this test if:

You are 65 or older and have other risk
factors for osteoporosis.

You are willing to make changes to your
lifestyle or take medicines if the test shows that you have
osteoporosis.

2. Compare your options

Have the DXA test

Don't have the test

What is usually involved?

The
DXA test is done in a radiology department or clinic.
It takes about 20 minutes.

X-rays are taken of the hip and spine
to measure bone thickness.

You may talk with your doctor about your risk
factors.

If you are worried about osteoporosis, you can
adopt healthy habits such as quitting smoking and getting more weight-bearing
exercise.

What are the benefits?

The test measures bone
thickness. It can help show if you are at risk for having broken bones
(fractures) because of osteoporosis, and it can help guide decisions about
treatment.

You avoid the costs of the
test.

What are the risks and side effects?

During the
X-ray test, you are exposed to a very low dose of radiation.

The
test is not recommended for pregnant women because of radiation exposure to the
developing baby.

You may be at
risk for broken bones from osteoporosis and not know it.

Personal stories

Are you interested in what others decided to do? Many people have faced this decision. These
personal stories
may help you decide.

Personal stories about deciding whether to have a bone density test

These stories are based on information gathered from health professionals and consumers. They may be helpful as you make important health decisions.

"I am uncertain about taking medicines for osteoporosis. I have a few risk factors for osteoporosis, but not many. I think that knowing my bone density would give me at least one objective piece of information I can use to make the medicine decision. It would also give me a baseline, so if I'm tested again in the future I can tell if my bone density has changed."

— Janet, age
65

"I have a number of risk factors for osteoporosis, and I have watched my mother's struggle with spinal fractures over the past few years. In her day, they didn't know as much about using hormones after menopause to prevent "brittle bones." I already take calcium and vitamin D and have already decided that I will take osteoporosis medicine, so my doctor and I agree that for now there is no real reason for me to have a bone density test."

— Annamaria, age 51

"I slipped on the ice last week and broke my wrist. It didn't seem like a very serious fall, and the doctor said that because of my age, she wondered if perhaps I might have osteoporosis. I had decided not to take hormones when I went through menopause, and I probably haven't been getting quite as much calcium as I should. I am going to have the bone density test and see if maybe I have osteoporosis. I hear there are some medicines that can help treat it. And either way, I will definitely start taking my calcium supplements."

— Elsie, age 71

"I was surprised to find that I don't have any risk factors for osteoporosis other than getting older. And I've always enjoyed drinking milk, so I don't have a problem getting enough calcium. I exercise, and I don't smoke or drink. Really, I think my bones are healthy! I'm not taking hormones after menopause, and I feel like I am at such low risk of getting osteoporosis that the bone density test isn't something I need at this point. I'm going to talk it over with my doctor."

— Sharon, age
55

3. What matters most to you?

Your personal feelings are just as important as the medical facts. Think about what matters most to you in this decision, and show how you feel about the following statements.

Reasons to have a DXA test

Reasons not to have a DXA test

I think I'm at risk for osteoporosis, and I want to know for sure.

I don't think I'm at risk for osteoporosis.

More important

Equally important

More important

I'm willing to make lifestyle changes and take medicines if I am at risk.

I'm not willing to make any changes or take medicines.

More important

Equally important

More important

The cost of the test doesn't bother me.

I'm worried about the cost of the test.

More important

Equally important

More important

My other important reasons:

My other important reasons:

More important

Equally important

More important

4. Where are you leaning now?

Now that you've thought about the facts and your feelings, you may have a general idea of where you stand on this decision. Show which way you are leaning right now.

Having the test

NOT having the test

Leaning toward

Undecided

Leaning toward

5. What else do you need to make your decision?

Check the facts

1.
Is getting the bone density test a good choice for everyone?

Yes

No

I'm not sure

You're right. You probably don't need this test if you are at low risk for osteoporosis and are younger than 65.

2.
Is it important to know your risk for osteoporosis?

Yes

No

I'm not sure

You're right. It is important to know your risk for osteoporosis. But you can find out without getting a bone density test.

Qaseem A, et al. (2008). Screening for osteoporosis in men: A clinical practice guideline from the American College of Physicians. Annals of Internal Medicine, 148(9): 680–684. Also available online: http://www.acponline.org/clinical_information/guidelines/guidelines.

Note: The "printer friendly" document will not contain all the information available in the online document some Information (e.g. cross-references to other topics, definitions or medical illustrations) is only available in the online version.

Qaseem A, et al. (2008). Screening for osteoporosis in men: A clinical practice guideline from the American College of Physicians. Annals of Internal Medicine, 148(9): 680–684. Also available online: http://www.acponline.org/clinical_information/guidelines/guidelines.

eMedicineHealth Medical Reference from Healthwise

This information does not replace the advice of a doctor. Healthwise disclaims any warranty or liability for your use of this information. Your use of this information means that you agree to the Terms of Use. How this information was developed to help you make better health decisions.